NPIMap

Organization Active NPI

La Clinica del Pueblo, Inc

  • Federally Qualified Health Center (FQHC)
  • Hyattsville, MD
National Provider Identifier
1194176834
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DEL PUEBLO, INC
Practice address
2970 Belcrest Center Dr
Suite 301
Hyattsville, MD 20782-1987
Phone
(202) 448-2845
Fax
(202) 332-0085
NPI assigned
Jun 23, 2016
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LA CLINICA DEL PUEBLOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Micaela Acuna
Title
Patient Revenue Manager
Phone
(240) 582-8828

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 650001047 DC
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2970 Belcrest Center Dr
Suite 301
Hyattsville, MD 20782-1987

Mailing address

2970 Belcrest Center Dr
Suite 301
Hyattsville, MD 20782-1987
Phone (202) 448-2845

Other names 1

  • La Clinica del Pueblo Hyattsville Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040228000337 DC Part B Supplier - Clinic/Group Practice 3971490558 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hyattsville, MD; Washington, DC
O20160921002121 MD Part A Provider - Federally Qualified Health Center (FQHC) 3971490558 Practice locations: Hyattsville, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194176834. Details of each certification follow.

Federally qualified health center certification: CCN 211907

Legal name
LA CLINICA DEL PUEBLO INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2016
Last certification
Aug 4, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Jul 1, 1995 in DC
Enrollment address
2970 Belcrest Drive
Suite 301
Hyattsville, MD 20782-9997

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2119638La Clinica del Pueblo- Hyattsville Site2970 Belcrest Center Dr, Unit #301, Hyattsville, MD 20782Provider-performed microscopySep 29, 2026

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Pueblo Inc5 organizations share this tax ID, including this one
Part of
La Clinica del Pueblo Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2831 15th St NW
Washington, DC 20009
Phone (202) 462-4788

2970 Belcrest Center Dr
Unit 301
Hyattsville, MD 20782
Phone (202) 462-4788

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Suyana Barker Individual Corporate OfficerChief Programs Officer Jan 1, 2019
Carlos Plazas Individual Corporate OfficerCfo/Coo Jan 1, 2024
W-2 Managing EmployeeCfo/Coo Jan 1, 2024
Amina Chaudhry Individual Corporate OfficerInterim Chief Health Officer Dec 2, 2024
La Clinica del Pueblo Inc Organization, Washington, DC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 27, 2016 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1194176834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 BELCREST CENTER DR",
            "address_2": "SUITE 301",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207821987",
            "telephone_number": "202-448-2845",
            "fax_number": "202-332-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 BELCREST CENTER DR",
            "address_2": "SUITE 301",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207821987",
            "telephone_number": "202-448-2845",
            "fax_number": "202-332-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DEL PUEBLO, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA CLINICA DEL PUEBLO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "ACUNA",
        "authorized_official_first_name": "MICAELA",
        "authorized_official_title_or_position": "PATIENT REVENUE MANAGER",
        "authorized_official_telephone_number": "240-582-8828"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "DC",
            "license": "650001047",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica del Pueblo Hyattsville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hyattsville, MD

Sources for this page

Verify at the official NPI Registry.